Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition

Abstract

Prior to the 1970s, blending food and liquids and putting them through an enteral access device (EAD) was the most common form of enteral nutrition (EN). However, in the 1970s, blenderized tube feedings (BTFs) became less popular due to the emergence of modern commercial enteral formulas (CEFs). Recently, a cultural shift toward consuming a natural diet, consisting of whole foods, has led to a resurgence in the use of BTF. The increasing use of BTF in a variety of patient care settings identifies a need for practice recommendations that provide guidance for nutrition professionals and patients. Members of the American Society for Parental and Enteral Nutrition (ASPEN) Enteral Nutrition Committee identified salient clinical questions concerning BTF, conducted a comprehensive literature search, and subsequently developed practice recommendations pertaining to the use of BTF. This paper was approved by the ASPEN 2022–2023 Board of Directors.

Knowledge and clinical practice of ASPEN registered dietitian nutritionist members regarding blenderized tube feedings

“…Although BTF use remains primarily driven by patient/ caregiver requests, a shared decision-making model is necessary to ensure patients/caregivers have the information required to make an informed decision. 3 RDN/Is should seek evidence-based BTF-related education/training, screen all enteral nutrition-fed patients for a desire to use BTFs, learn to develop client-specific BTF recipes, and counsel patients on food safety techniques to prevent microbial contamination and feeding tube occlusions. ASPEN, the Academy of Nutrition and Dietetics, and other leading nutrition organizations have an opportunity and obligation to develop BTFspecific education/training (eg, webinars, conferences, and workshops), evidence-based toolkits, and other resources to strengthen HCPs' knowledge and competence to better support patients/caregivers who desire to use BTFs.…”

“…10,[13][14][15] There are a lack of randomized controlled trials comparing CEFs with BTFs; however, observational studies indicate BTFs are associated with improved health outcomes and quality of life, such as decreased hospital use and increased patient satisfaction compared with CEFs. 3,16,17 More recent studies have shown that BTFs are safe and well tolerated. [18][19][20] Barriers to BTF use include the need for a specialized blender, time and labor involved in preparing BTFs, cost, difficulty managing BTFs away from home, concerns caused by commercial insurance coverage, and inadequate support from the family or HCP.…”

“…[18][19][20] Barriers to BTF use include the need for a specialized blender, time and labor involved in preparing BTFs, cost, difficulty managing BTFs away from home, concerns caused by commercial insurance coverage, and inadequate support from the family or HCP. 3,10,13 A study by Johnson et al 8 used a 16-question survey to assess 244 pediatric dietitians' attitudes, experiences, and perceptions of clinical outcomes of BTFs in their practice setting. Johnson et al 8 found that 58% of pediatric dietitians recommended or used BTFs in their practice.…”

“…These feeds, commonly referred to as blenderized tube feedings (BTFs), use a high-powered blender to liquefy whole foods that are immersed with liquids and administered through a feeding tube. 3,4 BTF use Whole foods remained the sole feeding substrate for patients receiving enteral nutrition until, in the 1960s-1970s, BTF use declined because of the advent of commercial enteral formulas (CEFs). 5 CEFs became the preferred source of nutrition because they had a known nutrient composition, were affordable, were easy to use, and had minimal chance of microbial contamination.…”

“…5 CEFs became the preferred source of nutrition because they had a known nutrient composition, were affordable, were easy to use, and had minimal chance of microbial contamination. 3,5 Because of increasing family/ patient requests for information or desire to use BTFs, a reemergence in BTFs has prompted questions on how many patients use whole foods as the basis for their formulas. Although the exact number is unknown, some recent studies have tried to ascertain the prevalence of BTF use.…”